Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6679 | CO |
NPI | 1003016148 |
---|---|
Provider Name | Gregory E Micheli |
First Address | Grand Junction, CO 81506-3908 |
Second Address | Grand Junction, CO 81506-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 18/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02066793 | (05) | CO |